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183 Cards in this Set
- Front
- Back
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When should you suspect an acid-base disorder?
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abnormal respiration
altered bicarb poor o2sat protracted vomiting/diarrhea altered mental status |
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What tests do you do to evaluate a person with an acid-base disorder?
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ABG's and chem panel
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What is the purpose of allens test?
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unlar circulation.
REQUIRED: because if you do a radial artery ABG, and the danm thing |
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How are ABG's written out? because they will hoze us on this
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pH/pCO2/pO2/HCO3/O2 sat/Base excess
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How do base excess related to acidosis or alkalosis?
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acid, if base has negative -2 or less excess
basic if base has +2 or more excess |
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what is normal blood ph range?
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7.35-7.45
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What is the primary problem in metabolic acidosis?
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low plasma bicarb
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what is the primary problem in respiratory acidosis?
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increased pCO2
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What is the primary problem in metabolic alkalosis?
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increased plasma bicarb
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What is the primary problem in respiratory alkalosis?
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decreased pCO2
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what is normal pCO2 level?
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40
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What is normal HCO3 level?
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24
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Will physiologic compensation of a primary acid base disorder normalize the pH?
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nope never on its own
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How does total venous CO2 relate to ABG bicarb?
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these should be about the same, or within +/- 3mmol/L
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How does pH change with variations in H+ nEq/L?
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the ph should change about .01 for every unit (1) change in H+ nEq/L in the Opposite direction***
(which makes sense, the more H+, the more acid, or lower pH) |
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IF acidotic and pCO2>40 it is?
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this is respiratory acidosis (due to high CO2
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If acidotic and HCO3<24 it is?
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metabolic acidosis, due to low HCO3
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if alkalotic and pCO2 <40 it is?
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respiratory alkalosis
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if alkalotic and HCO3 >24 it is?
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metabolic akalkaosis
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What is the ANION gap calculation?
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NA- (Cl + HCO3) = gap
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What is the normal anion gap?
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about 16
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what does an anion gap >20mmol/L predict?
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primary metabolic acidosis
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What does an Excess anion gap >30 indicate?
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metabolic alkalosis
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What does an excess anion gap <23 indicate?
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this indicates a non-anion gap metabolic acidosis
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How is excess anion gap calculated?
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(Anion gap- 12) + Measured bicarb (or venous Co2)
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What are the 7 things that cause high anion gap acidosis (anion gap above 20)
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MULE PAK
Methanol Uremia Lactic acidosis Ethylene glycol Paraldehyde Aspirin Ketoacidosis |
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What are the signs of ethylene glycol ingestion
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elevated osmlar gaps
calcium oxalate crystals |
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What is the normal osmolar gap?
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less than 10
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What do you suspect if osmolar gap is greater than 10?
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methanol or ethylene glycol ingestion
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how do you calculate osmolar gap?
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measured osmolalty- calculated osmolality
where calculated is 2(Na) + BUN/2.8 + glucose/18 |
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Why does dehydration push metabolic akalaosis along?
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the kidneys start to spare Na and fluid, rather than sparing H+.
and to spare Na (and volume) the kidneys will reabsorb NaHCO3- making the alkalosis worse normally it would spare H+ by dumping K and Cl |
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What does a urine chloride below 10 meq/l and alkalosis indicate?
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this indicates a NaCl responsive alkalosis
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How does the potassium level change in metabolic acidosis?
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as pH decrease, serum potassium increases
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How do you calculated the correct K+?
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for each .1 change in pH, K+ changes by .6mEq/L in the opposite direction
normal K+ is 3.7-5.2 |
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What is the ROME III criteria for dyspepsia?
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1 or more of:
postprandial fullness early satiation epigastric pain or burning |
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how often is dyspepsia functional/idiopathic?
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up to 60% of the time
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What are the alarm symptoms in dyspepsia?
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unintended weight loss
persistent vomiting progressive dysphagia odynophagia (painful swallowing) anemia hematemsis abdominal mass family hx of upper GI cancer prior gastric surgery jaundice |
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What do you do if your pt is over 45, and has dyspepsia alarm symptoms?
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Upper GI endocopy
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What is the first treatment for H pylori negative dyspeptics?
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4-8 week PPI trial
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What are the four major risk factors for upper GI adenocarcinoma?
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Tobacco smoking
H pylori infection alcohol intake Japanese |
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What are the initial symptoms of GI cancer?
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weight loss
abdominal pain N/V hematemessis |
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What is Leser-Trelat sign?
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explosive onset of multiple seborrhea keratoses of the skin (within a couple weeks)
associated with GI cancer |
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What is Blummers shelf?
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metastatic tumor felt on rectal examination
associated with GI cancer |
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What is used to evaluate suspect gastric caners?
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EGD #1***
CT endoscopic ultrasound |
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How many normal people will have an abnormal LFT test?
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about 5%
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What is the most common medication to raise LFT's ?
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acetaminophen (tylenol)
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What does an AST to ALT ratio of 2:1 or greater suggest?
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alcohol abuse
will also have high GGT |
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What things cause erosive and hemorrhagic gastropahy?
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NSAIDS
alcohol stress |
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What are the endoscopic findings in erosive and hemorrhagic gastropathy?
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subepithelial hemorrhages, petechia, and hemorrhages
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What is the most common clinical sign of erosive and hemorrhage gastropathy?
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bleeding, presenting as hematemesis, coffee ground emesis, or melena
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What is the best way to diagnose erosive or hemorrhagic gastropathy?
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Endoscopy is the BEST
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What is stress gastritis?
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mucosal erosions and hemorrhages that develop within 72 hours in critically ill pts (surgery, hospitalization)
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What is the main cause of nonerosive and nonspecific gastritis?
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H pylori
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What tumors does h pylori predispose you for?
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adenocarincoma
and low grade B cell gastric lympgoma |
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Does H pylori serology imply active infection?
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Nope
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What tests do indicate an active h pylori infection
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fecal antigen
urea breath test |
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What are the two main causes of peptic ulcer disease?
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H pylori
NSAIDS |
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What are the sxs of PUD?
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gnawing
dull aching burning or hunger like pain |
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What are symptoms of gastric ulcers?
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Anoxeia and weight loss
N/V |
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What must be done with all gastric ulcers?
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biopsided and follow up
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what is the classic presentation of duodenal ulcers?
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pain occurring 2-3 hours afte eating
also at night |
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What is the procedure of choice for diagnosing dudodenal and gastric ulcers?
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endoscopy
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What is the general approach to treating PUD?
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bland diet, frequent feedings
avoid NSIADs, booze, smoking |
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What are the BEST drugs for PUD?
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PPI's
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How long do you give PPI's for uncomplicated duodenal ulcers?
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4 weeks
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How long do you give PPIs for uncomplicated gastric ulcers?
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8 weeks
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What drugs are included in the quadruple therapy for H pylori?
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Quadruple therapy
PPI+ Bismuth + metronidazole + tetracycline |
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what drugs are included in the concomitant therapy for h pylori?
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PPI, clarithromycin, amoxicillin, metronidazole
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How do you get most platelet disorders?
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aspirin, or ITP- so acquired
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How do you get most coagulation cascade disorders?
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congential defects
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What test is increased in hemophilia A?
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PTT (factor 8)
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What tests are increased in vWF disease?
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bleeding time, PTT
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What test is increased in wit K deficiency?
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PT (maybe PTT too)
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What tests are increased in heparin/coumadin overdose?
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PT and PTT
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What tests are increased in DIC?
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bleeding time, PT, PTT
but platelets are decreased |
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What defines thrombocytopenia?
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less than 100,000 platelets
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How does TTP present?
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a microangiopathic hemolytic anemia. thrombocytopenic purpura, renal failure
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What causes TTP?
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unclear- but platelet aggregation
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What does the periperal blood smear show in TTP?
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schistocytes, and low platelets
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How do you diagnose ITP?
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by exclusion
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Who gets ITP?
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this is usually kids, with a preceding viral infection
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What factor is defective in hemophilia A?
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factor VIII (8)
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Who gets hemophilia?
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only males (x linked)
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What are the genetics of von willebrands disease?
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autosomal dominant
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What are the vit K dependent factors?
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2, 7, 9, 10
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what are the three principles of managing bleeding disorders?
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stop bleeding
treat cause give blood component |
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What are packed red blood cells given for?
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lost red cell mass
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What is fresh frozen plasma given for?
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factor defects, coumadin reversal, TTP tx
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What are platelets given for?
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platelet counts below 50,000 and clincally abnormal bleeding
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What are the four phases of clotting?
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vascular (disruption of wall)
platelet phase (platelet adhesion and plugging) Coagulation- turns int a fibrin clot fibrinolysis- dissolving clot (resolution) |
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where do most vascular disorders come from?
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typically acquired
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do all pts over age of 50 need annual fecal occult testing with guaiac cards?
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NO
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What are the 3 USPSTF testing regimins for colon cancer?
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YEARLY Fecal occult blood testing
or Sigmoid ever 5 years, and FOBT every 3 or Colonoscopy every 10 |
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What ages does USPSTF recommend screening for colon cancer for?
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Age 50 thru age 75
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While the american cancer society reccomends the same 3 tests for colon cancer as the USPSTF- what other 3 does it also want?
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double-contracts barium enema every 5 years
or CT colonography every 5 years or fecal DNA at some interval |
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What are four risk factors for breast cancer show in turning point?
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over 50
no pregnancies history of atypical ductal hyperplasia on biopsy late cessation of menses |
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What is the biggest risk for breast cancer?
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first degree relative with breast or ovarian cancer at early age
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How does oral birth control affect cancer rates?
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this increases them
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When does the USPSTF recommend breast cancer screens?
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FOR- Biennial between 50 and 74
Against self breast exam (women are too stupid to do it right) FOR clinical breast exam over 40+ |
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What does the american college of obstetrics and gynecology say about breast cancer screens?
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mammogram every 1-2 year for 40-49
and yearly after 50 ALSO- FOR self breast exam |
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What age do you start doing PAP smears?
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21 years old
or 3year after onset of sexual activity |
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What HPV types cause cervical cancer?
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16,18,31,45
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At what age do you start HPV testing
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age 30+
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What does ACOG say about negative HPV DNA test results?
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HPV dna testing is very sensitive, and so if its negative, cancer risk is about 1/1000
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Does USPSTF recommend testing for HPV?
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no
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What is Oligomenrrhea?
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cycles longer than 35 days, but less than 6 months
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What is hypomenorrha?
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regular cycles, but with shorter duration
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What is menorrhagia?
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regular cycles with heavy flow, or long duration
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what is metrorrhagia?
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bleeding between cycles
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What is Dysmenorrhea?
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painful menstruation that prevents a woman from doing normal activities
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What are the two types of dysmenorrhea?
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primary- excess prostaglandins
secondary- identifiable cause |
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what chemical causes primary dysmenorrhea?
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prostaglandins
common in younger women |
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What kinds of things cause secondary dysmenorrhea?
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endometriosis
adenomyosis PID adhesions leiomyomas |
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What is the presentation of secondary dysmenorrhea
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monthly spasmodic lower abdominal pain on first 1-3 days of menses
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What is primary amenorrhea?
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no menses by age 13 without sexual development
or by age 15 with sexual development |
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what is the order of the arche is female development?
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thelarche (breast)
pubarche (pubic hair) menarche (periods) |
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What are the four most common causes of primary amenorrhea?
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ovarian failure (tuners)
no uterus GnRH deficiency- Kalman ansomia constitiutional delay |
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what is the most common cause of secondary amenorrhea?**
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pregnancy
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What are the most common not pregnancy cause of secondary amenorrhea?
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PCOS
hypothalamic lactation menopause |
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what is the hypothalamic cause of secondary amenorrhea?
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decreased GnRH pulsatility, decreases FSH and LH
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What things cause the hypothalamus to decrease GnRH pulastility?
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strenuous exercise or stress
weight loss hypothalamic lesions |
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What is elevated in secondary amenorrhea caused by ovarian failure?
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FSH is elevated
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How does Polycystc ovarian syndrome cause secondary amenorrhea?
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this is hyperdrogenic, and inhibits GnRH release
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what is the most common cause of androgen excess and hirsuitism?
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polycystic ovarian syndrome
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what hormone is in excess in PCOS?
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excess LH
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What are the AEIOU causes to do Dialysis?
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Acidosis
Electrolyte disorder Intoxiation (methanol, aspirin) Overload volume Uremia |
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What GFR defines chronic kidney disease
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<60ml/min for 3 month of more
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What drugs help in chronic kidney disease cause by HTN
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ACEi
ARB's |
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What is renal osteodystrophy?
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at Low GFR's, PTH levels rise,
bones thin |
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What does ADH do?
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this regulates sodium concentration
increases water uptake |
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What does aldosteone due?
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increases sodium uptake
and increases secretion of potassium |
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What defines hyponatremia?
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sodium under 135
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what is hyponatermia a disturbance of?
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free water, and reflects problems in water homeostasis
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What are the labs in SIADH?
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low sodium in blood
high sodium in urine high urine osmolality low serum osmolality |
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how do you treat SIADH?
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reduce water in take
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what is the most common cause of diabetes insipidus?
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idiopathic low ADH secretion
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What is functional constipation?
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this is constipation with no identifiable cause
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what is encopresis?
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regular, voluntary or involuntary pooping your pants after age 4
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what is Soiling?
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involuntary passage of stool associated with fecal impaction
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what is are the key signs of hirschsprung disease?
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delayed passage of meconium
chronic constipation soiling empty rectum and tight sphincter |
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What is functional constipation?
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this is constipation with no identifiable cause
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what is encopresis?
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regular, voluntary or involuntary pooping your pants after age 4
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what causes anal fissure?
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big hard dump
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what is Soiling?
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involuntary passage of stool associated with fecal impaction
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What is primary enuresis?
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incontinence in a child who has NEVER achieved dryness
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what is are the key signs of hirschsprung disease?
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delayed passage of meconium
chronic constipation soiling empty rectum and tight sphincter |
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what is secondary enuresis?
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incontinence in a child who has been dry for at least 6 months
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what causes anal fissure?
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big hard dump
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What is primary enuresis?
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incontinence in a child who has NEVER achieved dryness
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what is secondary enuresis?
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incontinence in a child who has been dry for at least 6 months
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What is the spontaneous remission rate of enuresis?
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15%
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does enuresis usually run in families?
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yes it does, the parents often had it as kids
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What should a exam for enuresis include?
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observation of kid for abuse
and noting child parent interaction |
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what are the treatments for enuresis?
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conditioning therapy- enuresis alarm LOL
pharmacotherapy hypnotherapy |
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What is reflux nephropathy?
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renal scarring from the vesicoureteral reflux
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What structural conditions lead to vesicoureteral reflux?
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duplication of ureters
neurogenic bladder |
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What are the diganostic studies you should do with in kids up to age 6 with a first documented UTI?
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voiding cystourethrogram VCUG
radionuclide cystogram NCG |
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what type of scan best identifies renal scars (in vesixoureteral reflux)
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nuclear renal scanning
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what are the complications of VUR?
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HTN, chronic kidney disease
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What is the triad of HUS?
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microangiopathic hemolytic anemia
thrombocytopenia renal injury/ acute renal |
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How do you tell TTP from HUS?
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TTP does NOT have a diarrheal prodrome!
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What is pubarche?
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appearance of hair, oily skin, acne, body odor
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What does adrenarche NOT include?
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development of breasts or testicular enlargment
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What does Gonadarche cause in males?
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pubic hair, axially hair, manly stuff
increases penile size, increased testicular volume |
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What is Kallmann synrome?
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gonadotropin deficiency with disorders of olfaction
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How does increased phyiscal activity change the onset of menarchy?
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this can delay onset
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When should you consider Turner syndrome?
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any girl who is short without a contributary history
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What is precocious puberty?
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early development of secondary sex characteristics (before 8)
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what is gonadarche?
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maturation of gonad and secretion of sex steroids
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What is the normal developmental sequence in girls puberty?
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thelarche (breast)- due to gondarache
pubarche (due to adrenarche) menarche 2-3 years later |
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What is central precocous puberty?
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all development comes early- usualyl constitiutional or familial basis
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What is McCune-Albright syndrome?
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this is the most common cause of GnRH independent precocious puberty
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What are the signs of McCune-Albright syndrome?
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cafe au lait spots
early gonadarche bone disorder hyperthyroidism, hyperadrenalism, acromegaly may occur too |
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When do you get the disease in a case control vs cohort study?
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cohort studies- compare disease incidence between exposed vs. unexposed
case control- compares diseased vs. well |
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What is absolute risk?
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this is number of new cases per year
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What study type CANNOT use absolute risk?
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case control, because you can assess incidence (due to the population being non random)
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What is absolute risk reduction?
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AR of exposed- AR of unexposed (AR being # of new cases/ total)
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What is relative risk? (RR)
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AR exposed/ AR unexposed
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What does a RR=1 mean?
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no evidence you've identified a risk factor
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What does RR >1 mean?
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evidence for risk factor (risk in exposed is greater than risk in unexposed)
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What does RR<1 mean?
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evidence for protective factor
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What is the Odds ratio?
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ad/bc
(when using a square chart) |
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What is the number need to harm ?
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NNH = 1/ Absolute Risk reduction
(ARR = AR exposed - AR unexposed) |
